Health care in the U.S.: My experiences

After having spent most of my life in India/Kenya, visiting a doctor here in US turned out to be a real eye-opener, an unforgettable experience! I have had an issue with my wisdom teeth for the last 4 years. The two in my lower jaw don't trouble me (as yet), but the two in my upper jaw have been trying to peep out for the last four years. Splitting headaches once in a while, pain in the gum when a tooth is finding its way out, referred pain in my other teeth, I have seen it all. What my dentists in Nairobi/Hyderabad thought about this issue: Wisdom teeth are best left untouched as long as they don't trouble me much. A single Xray in Nairobi in November'08, and my dentist told me to just watch the situation. My headaches reduced, the right side tooth fully erupted without any issue. (The left side one started erupting next.) I was told that in case my teeth supraerupt later & cause any issue, I can opt for extraction. But let them be otherwise! During my stay here in NewYork, over the last few months, I woke up on several nights with a parched mouth, my left wisdom tooth was biting a wound onto the inside of my cheek.. Given how expensive healthcare is here in US, especially dental care, I waited for my upcoming trip to India. My dentist in Hyderabad advised me to get my upper jaw's wisdom teeth extracted because they were biting onto my cheek and creating problems. He opened my mouth wide, examined my teeth, took his own time peering in, and finally announced that they should be extracted (they were fully out and supraerupting). He also looked at the Xray taken in Nairobi in November'08. Teeth extracted in Hyderabad, I was going around with my mouth shut, on painkiller for three days, the pain didn't subside, I was worried about the healing, since my roots were longer/deeper than normal. So my dentist dressed my right side extraction site. It was a pain relief cum disinfectant to promote healing. He also advised me to take antibiotics, since I told him that I will be in big trouble if the pain doesnt subside fast before I leave for US. Ten days after coming to the US, I brushed my finger against my extraction sites. Horror horror, I felt a sharp projection on the right side! O my God, perhaps a piece of tooth broke off inside my mouth!!! That is how my ordeal with the healthcare system in the US began, and that is what this story is all about! I knew I needed to see a dental surgeon (an oral & maxillofacial surgeon), but apparently, they are super-specialists hardpressed for time, and only accept patients by referral! So a maxillofacial surgeon's secretary told me to first book an appointment with a general dentist. My husband called up the general dentist, but his secretary said that a suspected case of broken wisdom tooth falls under oral surgery and refused to book an appointment for me! I was stuck in no man's land!!! Finally, my husband went to the dental practice, and explained the situation to them, that I need to see a surgeon, so either they should let me book directly with a surgeon, or allow me to see a general dentist. So on a wednesday afternoon, I got an appointment with a general dentist for thursday morning, knowing full well that he will in turn refer me to the oral surgeon probably for monday, and that I will have to live with the tooth particle over the weekend! what a time waste, had I been in India, I would have stepped into my dentist's office at any time and he would have extracted the particle in a jiffy, I could feel it with my finger! On Thursday morning, I got an everlasting taste of American healthcare! Even before the dentist saw me, an Xray technician took 18 Xrays of all possible angles of my jaws! EIGHTEEN XRAYS!! MY GOD, I was exposed to SOOOO MUCH radiation, knowing all along that there is a particle in my right side upper jaw! My Indian dentist didnt need one single Xray to even extract the teeth, but here they need 18 Xrays! Apparently, it is a norm for all new patients and the entire set goes on my file, and will be redone every 3 years... Gosh... I come from a land where there is a shortage of funds, where even patients who actually need technology/machines dont find access to them... whereas here, there are plenty of machines, and one way of using them is to make every patient go through the process blindly, as a protocol! Finally, the dentist came into the room to see me. He checked my teeth, asked me when I have last had a dental cleaning done, the nurse gave me a card which specifies my next appointment in six months time for a cleanup. Then we came to the point, I told him about my wisdom teeth extraction, and how I suspected a particle to be lodged in my gums. I told him I had my extracted teeth with me, would he like to have a look, he said no need since he has 18 Xrays! He plucked out one of those 18 Xrays, and told me that yes, there is a dental root left in my mouth! Can I see my left jaw on Xray, it is now empty where the wisdom tooth was, but on the right jaw, there is a clear opaque object, a broken root!!! I can get infected because of it, it is very dangerous, I need to see a surgeon right away. Also, I have two wisdom teeth inside my lower jaw which haven't yet erupted, but they're deep inside my jaw, they need to be surgically removed! He took one quick glance into my mouth and told me, there it is, I can see your white tooth particle! Please wait in the waiting room, you need to see a surgeon right away, there is an oral maxillofical surgeon right across the hall... So my husband & I at last got the chance to see the surgeon, at last reached the point which we wanted all along... After waiting for five minutes in the surgery, I thought over, I know I wont get my lower jaw's wisdom teeth surgically removed, these people here are obsessed about everything to an extreme. I wont get teeth which dont trouble me removed, that itself can cause so many other complications, what if a nerve is touched, why will I go into surgery for issues which dont trouble me.. Also, I know how terribly expensive it will be.. But regarding the particle lodged in my right upper jaw, will I really get infected? But I feel no pain, no swelling 2 weeks after extraction, it might just heal.. Even if I DO really need an extraction, it will be so expensive here in US, most probably cheaper to fly to India, perhaps it's not such an emergency, let me ask my mom, my husband is getting late to work, how long can we wait here, let me take an appointment for tuesday, I know I wont die of infection before tuesday... I came home on thursday afternoon with the particle still in my mouth, with a tuesday appointment for surgical removal... I spoke to mom, being a microbiologist, she said the dentist is right in theory, broken splinters of bone/cartilage/dental roots do cause infection.. But in practicality, if I dont feel any pain/swelling/discomfort 2 weeks after extraction, it might heal in all probability... She gave me one sterling piece of advice, to call up my dentist in India... I called him up and told him, I feel a sharp protrusion in my upper right jaw... With great confidence, he brushed me off, "Dont touch it, it will pain for sometime, it's a bony protrusion, it is not a broken piece of tooth, it will get ground down with time".... But I told him about the distinct shadow in the Xray... Once again with great confidence, "There is no question of a broken tooth root, the protrusion you feel is a bone outgrowth which shouldn't be tampered with until it has healed. I dressed your extraction site with a compound that contains metallic oxides, it will show up on the XRay as a distinct shadow."... I told him I had no discomfort, no pain, no swelling, I was fine, I just cancelled my tuesday appointment and ended the story there... My Indian dentist explained his understanding of American doctors, even if they see a small black spot, they will begin digging everything up, at any cost, even if it doesnt interfere or trouble... Lessons I learnt from that, I am a layman, I can't know that metallic oxides show up on Xray, but how could the general dentist mistake that for a dental root? He actually didn't bother to look into my mouth, he took a very quick peek in and announced that he can see my "white" root, now I know that it was my white "dressing" which subsequently fell out and I preserved it, it is really root shaped... I told him that I feel a protrusion, he didnt bother to feel it, he assumed it to be the shadow showing up on the Xray, he didnt realise that my protrusion was elsewhere, and the so called "dental root"s shadow was elsewhere! I carried my extracted teeth with me to the US, the dentist could have examined them to see if a root had broken off, I know now that they were intact! EIGHTEEN XRays, what is the point of technology/engineering and advances in imaging if a dentist doesnt have the time to look into my real mouth which I can open right there? Perhaps I have a very wrong perception of this whole affair, perhaps I am a stingy person coming from a developing country, since I come from a place where doctors have to think 100 times before prescribing tests, they're too expensive and in shortage... Where I come from, our doctors are soooooo busy dealing with real problems, they dont believe in poking their nose into non-existent problems (like wanting to operate on my teeth which were inside my jaw and not even troubling me)... Where I come from, we may not have the technological know-how to do great fantastic feats in medicine, but our doctors use their God given eyes/ears/hands to make basic common sense diagnosis instead of blindly exposing a patient to unnecessary XRays... Perhaps there are some patients who greatly benefit from 18 dental Xrays, perhaps the doctors here unearth some critical life threatening ailments and prevent them from such routine complete checks... But I didnt have any critical illness, and even my basic problem was misdiagnosed because a doctor relied more on Xrays & ignored the gift of his eyes/hands. Finally, the colossal cost... The Xrays are covered by insurance, couldn't that be one of the reasons doctors blindly prescribe a set of tests to one & all? It could also be because they fear being sued later for negligence... but in my case, 18 Xrays and still negligence (a kind of negligence isn't it?). I still shudder, what if I walked into the surgeon's room, would he have been blind like the general dentist and tried to wrench off my bone? Or would he have made an incision to remove my tooth particle but instead removed my dressing? Subsequently, I came to know of a case where a dental surgeon damaged a patient's nerve, he cant taste food for life, he feels numb in his mouth forever... Another relative of mine was similarly suffering from wisdom teeth headaches, his dentist here advised him to go for surgery to remove the teeth because they were close to a nerve... The relative very wisely flew to India, where the dentist simply extracted them neatly without surgery, and he is fine now... I dont understand the system here, perhaps it is great in that it helps patients who have some mysterious big time illnesses... but what about routine illnesses/health issues, is it necessary to blow them up this way? Too much focus on bigtime illness is ok, but is it necessary to complicate & magnify small issues? Coming to super-specialists & their precious time, I saved that surgeon's time, my own teeth, my own time, my own money and a lot of pain by just calling up my Indian dentist, he understood the situation better on phone, which even 18 Xrays cant provide... What is the point of a general dentist being in such a hurry, he didnt save the superspecialist's time, he didnt save my time, he is the one who should have dismissed my case.. Thank God for everything, Thank God for the final outcome... It has been three weeks since this episode, I am alive and kicking, I didnt die of septicaemia, I live with my lower wisdom teeth still inside my jaw, but I have the unique privilege of having been exposed to EIGHTEEN shots of Xrays like a photoshoot, for no reason at all.... And my file doesnt belong to me, I will have to pay and buy my own copy of Xrays from the dental firm if I ever want to show them to my doctor in India... I know India or Kenya are full of quacks, perhaps I was never exposed to them because I am a doctor's daughter, I know private practicians all over the world over prescribe unnecessary tests and may be incompetent, but it is especially appalling to see such things here in U.S. where the entire system (doctors & insurance) is organized & tracked.....

Things They Don't Tell You About America

It has been over 8 months since I am living here in New York City, I have come across lots of positive things to appreciate about life here, but every immigrant has something positive to say, and hence I decided to take a different route...

One of these days, I can publish a book, "Things they don't tell you about America"... Wait a minute, I can publish my thoughts just now in the form of a blog! :-)

The "They" in the title stands for "Immigrants from developing countries".

I have seen soooo many cousins, friends, relatives migrating to the US, they come back to India/Kenya and complain about all bad things in India/Kenya and talk only of the great things in America...

But I was surprised to know that nobody ever told me about the problems I could face here!!!

Life was fine for the first 2 months... Then I developed a mild itch. Next the itch turned soooo severe, I rushed to a dermatologist expecting a severe allergy problem (I attributed it to carpets, since I am asthmatic) or a skin infection of some bizarre kind... It reached a stage when I couldn't sleep, I used to keep itching throughout the night, literally like an animal, I had bleeding wounds all over my body... Thank God I speak English & could communicate with everyone, otherwise someone could have mistaken me as a victim of Asian domestic abuse & put my poor darling husband behind bars ;-)

The dermatologist took one quick look at me, and told me that this is a typical condition, called "Winter eczema", associated with immigrants from warmer climates! Apparently, my body is not used to severe cold, nor is it used to the intense heat generated by the apartment heaters, so my skin dried up from within over two months until I developed a severe itch. The dermatologist said she sees cases like me ALL THE TIME, and that I needn't worry. I was prescribed some anti-histamines, some strong moisturizers, steroid ointments, with itch relief medication. In the waiting room, I saw so many patients from the Indian subcontinent, all of them new to USA. I went for a follow up twice, my medicine dosage was increased, I was prescribed stronger corticosteroid ointments to heal my skin.. The moment I told my cousin about my skin problem, she said she too has it, only that her skin is okay but her nose bleeds in winter!! Yet another cousin said his skin literally turned black because of pigmentation... Another friend said his nose bleeds... Then one of them announced, every state in the USA has its own version of severe weather, stretching from severe snow to regular tectonic tremors to hurricanes, tornadoes etc...

It's okay, I take such things in stride, thank God I didn't have a serious medical condition like a fungal infection or allergy.

It was my husband's turn next! He started complaining of a feeling of obstruction down his throat, it was finally diagnosed as another version of winter dryness, his mucus membranes dried up... :-D

Then I wondered, how come "They" told us wonderful things about America all these years, but "They" didnt bother to tell us about how irritating the weather/lifestyle here can be??? How come "They" are ready to complain about power cuts/bad roads/pollution/congestion in India, but don't tell us about how difficult life can be here?

And all this 'hulchul' in my life over nothing, there wasn't one single bug in our apartment!

I just knew that I need to write on this topic, because it keeps running through my mind all the time... I don't like people who unnecessarily criticize one country while endlessly praising another one. Nor do I like blind Indian patriots, they are another extreme in that they hate everything about NRIs until they have the oppurtunity to be an NRI themselves ;-)

The point of my writeup is, no place is perfect, every place has its own list of conveniences & drawbacks, and most important of all, we should learn to respect the place where we were brought up, as well as the place where we live currently, because we owe our past, present and future to where we lived/live...

My story doesn't end here, I have another topic on my mind that I am itching to write about, but it is not "Things They Don't Tell about America", it is a much discussed topic, and it deserves a blog entry of its own! Its about my limited experiences with the health-care system, something that really deserves a lot of sonch vichaar!